我国肺栓塞患者直接医疗费用及影响因素分析——基于2014年全国城镇医疗保险抽样数据-中国药房

我国肺栓塞患者直接医疗费用及影响因素分析——基于2014年全国城镇医疗保险抽样数据

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篇名：	我国肺栓塞患者直接医疗费用及影响因素分析——基于2014年全国城镇医疗保险抽样数据
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摘要：	目的：研究我国城镇肺栓塞患者的直接医疗费用及其影响因素，为肺栓塞的医疗费用控制及相应抗凝治疗药物的报销策略调整提供实证参考。方法：基于2014年全国城镇基本医疗保险数据，采用等距抽样法抽取肺栓塞患者信息形成样本数据库。根据样本数据库中肺栓塞患者的相关治疗信息和费用信息，对其人口学特征（包括性别、年龄、医保类型、地区、医疗机构类别等）、直接医疗费用以及不同抗凝药治疗组患者直接医疗费用等进行描述性分析；运用多元回归分析评价可能影响肺栓塞患者医疗费用的因素。结果：纳入肺栓塞患者475例，就诊记录共计1 090次，次均住院天数为12.37天。患者人均年医疗费用为10 847.42元（中位数为4 113.00元），人均住院费用为19 056.30元（中位数为13 042.86元），人均门诊费用为1 049.61元（中位数为418.70元）。亚组分析显示，东、中、西部城市人均年医疗费用为9 203.54、16 931.99、15 891.21元；三级医院就诊患者人均年医疗费用最高（11 733.40元），其次为二级医院，最低为其他医疗相关机构。在不同抗凝药治疗组中，联合使用低分子肝素和普通肝素组患者的人均年医疗费用（24 553.80元）和人均年药品费用（12 088.96元）均最高，仅使用华法林进行抗凝治疗患者的人均年医疗费用（2 350.24元）和人均年药品费用（1 163.67元）最低。多元回归分析显示，就诊类型（住院或门诊）、医疗机构类别、并发症对肺栓塞患者的次均医疗费用有显著影响（P＜0.05）。结论：肺栓塞患者的人均直接医疗费用仍较高，疾病经济负担仍较重；联合使用低分子肝素和普通肝素进行抗凝治疗的肺栓塞患者人均医疗费用最高；就诊类型、医疗机构类型、并发症情况能显著影响患者的医疗费用。
ABSTRACT：	OBJECTIVE： To study direct medical expense and its influential factors， and to provide empirical reference for medical expenses control of pulmonary embolism and the adjustment of anticoagulant drug reimbursement strategy. METHODS： Based on the national urban basic medical insurance data in 2014， the data of patients with pulmonary embolism were extracted by equidistant sampling method to form a sample database. According to related therapy information and expense information of pulmonary embolism patients in sample database， descriptive analysis was performed for demographic characteristics of patients （including gender， age， type of medical insurance， region， type of medical institution， etc.）， direct medical expenses and direct medical expenses of patients with different anticoagulants， etc. Multiple linear regression analysis was used to analyze potential influential factors for the medical expenses of patients. RESULTS： A total of 475 pulmonary embolism patients were included， a total of 1 090 visits were recorded， and the average length of stay was 12.37 days. The annual medical expense per capita of patients was 10 847.42 yuan （median was 4 113.00 yuan）， hospitalization expense per capita was 19 056.30 yuan （median was 13 042.86 yuan）， and outpatient expense per capita was 1 049.61 yuan （median was 418.70 yuan）. Results of subgroup analysis showed that annual medical expense in eastern， central and western cities were 9 203.54， 16 931.99 and 15 891.21 yuan. Per capita annual medical expenses of patients in tertiary hospitals were the highest （11 733.40 yuan）， followed by secondary hospitals， and the lowest was other medical related institutions. Among different anticoagulants treatment groups， the annual medical expense per capita （24 553.80 yuan） and annual drug expense per capita （12 088.96 yuan） were the highest in anticoagulant regimen of combined use of LMWH and UFH， while patients treated with warfarin alone had the lowest annual medical expense per capia （2 350.24 yuan） and annual drug expense per capita （1 163.67 yuan）. The multiple linear regression showed that the factors affecting medical expense per visit were type of patient （inpatient or outpatient），type of medical institution and type of complications. CONCLUSIONS： Direct medical expense per capita of patients with pulmonary embolism is still high， and the economic burden of disease is still heavy. Patients with pulmonary embolism treated with combination of LMWH and UFH had the highest medical expense per capita. The types of visit， types of medical institutions and complications can influence medical expense of patients significantly.
期刊：	2019年第30卷第22期
作者：	王俊锋，杨莉，吴静静，何丽月
AUTHORS：	WANG Junfeng，YANG Li，WU Jingjing，HE Liyue
关键字：	肺栓塞；城镇医疗保险；直接医疗费用；疾病经济负担；多元回归分析；抗凝药；影响因素
KEYWORDS：	Pulmonary embolism； Urban medical insurance； Direct medical expense； Disease economic burden； Multiple regression analysis； Anticoagulants； Influential factors
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